Survey Report PDF

THE PRICES PEOPLE HAVE TO PAY FOR MEDICINES
IN INDONESIA
Center for Health Services and Technology Research

National Institute of Health Research and Development
Ministry of Health Indonesia
In collaboration with:
WHO Jakarta
Health Action International
2004 - 05
RESEARCHERS:
ASIH EKA PUTRI

SELMA SIAHAAN
LUKI TJAHJONO
Researchers from National Institute of
Health Research and Development
(NIHRD)-MOH
MARTUTI BUDIHARTO
SITI SUNDARI
TRIJUNI ANGKASAWATI
RACHBUDI HELMI
RATIH ARININGRUM
INGAN TARIGAN
Data Analysts from National Institute of

Health Research and Development
(NIHRD)-MOH
ENDANG INDRIASIH
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List of Contents
Executive summary............................................................................................................................. 3
Conclusions and recommendations................................................................................................... 4
1. Introduction and Background........................................................................................................ 6
1.What prices do people pay for key medicines?............................................................................. 7
2.Do the prices and availability of the same medicines vary in different sectors: public
pharmacies, private pharmacies and other outlets?....................................................................... 7
3.What is the difference in prices of innovator brands and generically equivalent medicines? 7
4.How do procurement prices compare with international reference prices and with local
retail prices?........................................................................................................................................... 7
5.How affordable are medicines for ordinary people?.................................................................... 7
2. Methods......................................................................................................................................... 10
0National Institute of Health Research and Development (Host Institute)............................. 13
0Directorate of Pharmacy and Medical Devices, Ministry of Health (Collaborator and Local
Investigator) ....................................................................................................................................... 13
0National Agency of Food and Drug Control (Collaborator).................................................... 13
0Management Science for Health Indonesia (Collaborator)....................................................... 13
0Indonesian Pharmaceutical Association (Collaborator)............................................................. 13
0WHO Indonesia Office (Collaborator)........................................................................................ 13
0Provincial Health Offices 6 provinces (Collaborator)............................................................. 13
0District Health Offices 12 districts (Collaborator and local investigator)............................ 13
3. Data Collection and Analysis....................................................................................................... 15
4. Results............................................................................................................................................ 18
4.1 Availability of the medicines on the day of data collection.....................................18
4.2 Public sector procurement prices ............................................................................ 19
4.3 Public sector patient prices and availability.........................................................20
Private sector patient prices and availability.............................................................22
Medicine prices and availability in the other sector...............................................24
4.6 Price Variation Across Sectors................................................................................ 24
4.7. Price variation across regions - private sector........................................................ 25
4.8 Treatment affordability............................................................................................ 27
4.9 National prices in an international perspective........................................................ 27
5. Discussion....................................................................................................................................... 29
6. Conclusions and recommendations............................................................................................ 33
ANNEX 4 Data Collection Form ................................................................................................. 43
SURVEI HARGA OBAT NASIONAL BADAN LITBANG DEPKES RI.........................43
Formulir Pengumpulan Data Harga Obat F-1............................................................................. 43
Gunakan satu formulir untuk masing-masing fasilitas kesehatan............................................... 43
VerifikasiVerification.................................................................................................... 44
FORMULIR PENGUMPULAN DATA HARGA OBAT F-1MEDICINE PRICE
DATA COLLECTION FORM .................................................................................... 45
ANNEX 8 A list of Standard Treatment Affordability................................................................ 58
Executive summary
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The National Institute of Health Research and Development of the Ministry of Health has
carried out a field study to measure the prices and availability of medicines using the
WHO/HAI price measurement methodology. Data on the prices and availability of 42
medicines were collected in the public, private for-profit and other sectors in six provinces
representing four regions of Indonesia - Capital region and Java island (Jakarta and Jawa
Timur), Western part of Indonesia (Sumatera Selatan), Central part of Indonesia (Kalimantan
Selatan and Sulawesi Selatan), and Eastern part of Indonesia (Papua).
The study took place in one municipality and one district in each selected province. The cost
of treatment was calculated for 12 treatments and compared to the daily wage of the lowest
paid unskilled government worker. The price analysis was limited to 33 medicines, while the
other 9 medicines are to be analysed separately as a component of TRIPs study.
The results show that in Indonesia, the prices of medicines are high and with small variation
between public and private sector and between regions. In general, the prices of the
innovator brand products were much higher than international reference prices; on average
they were more than 20 times higher. They were also about 2-7 times higher than the most
sold generic equivalents and, in some cases, more than 10-15 times higher. The lowest price
generic equivalents were also expensive. In public procurement for primary healthcare prices
of generics were found to be on average 74% higher than the international procurement
prices. The patient prices in public hospital pharmacies and in private for-profit sector
(private retail pharmacies and private hospitals) are almost identical.
Affordability analysis showed that treatment of diabetes with innovator brand glibenclamide
from a private pharmacy would require 8.4 days wages to pay for a months supply. In
contrast, treating diabetes with generic glibenclamide is less than tenfold as expensive,
requiring 0.6 days wages in both public and private pharmacies. A weeks treatment for
pneumonia would require 1.5 days salary to pay for innovator brand amoxicillin, 0.4 days for
a generic.
Conclusions and recommendations

The principal conclusions of the study are as follows:
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Prices are high compared to international reference prices in public and private
pharmacies and there are large differences between innovator brand and generic
equivalent products.
The prices of generic medicines vary and the cheapest generic equivalent is not always
the most sold.
The availability of medicines in public sector, especially in public procurement, is far

from optimal. This could be due to a restricted list being used in public sector and not
corresponding well with the list of medicines surveyed.
The price difference between what patients pay in public and private sectors are small.
Generics are widely available in all sectors and the prices are much lower than innovator
brand products making treatment more affordable for most people but we do not know
whether they are being promoted and sold as often as they should.
The prices vary little across regions in Indonesia and suggests that distribution and
transportation cost have little influence on final price.
Indonesian public health sector is inefficient in procurement as prices obtained are on

average almost two times the international procurement prices.
On the basis of the findings of the study, the following recommendations are made to the
Ministry of Health Indonesia.
1. For a large country with a diverse healthcare sector such as Indonesia, this survey is
not large enough to draw firm conclusions. Similar surveys should therefore be
conducted by state.
2. An extended survey should be undertaken to ascertain the reasons for the high prices
and the large prices differences between innovator brands and generic equivalent
products.
3. Measures should be taken to lower patient prices in public sector, making public
sector an attractive alternative.
4. A policy favouring the use of generic medicines should be strengthened by
introducing quality assurance to increase professionals and patients confidence.
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5. Inefficient public procurement should be elaborated and solved by following possible

approaches:
Competitive tender with price transparency
Use international reference prices as guidelines
Introduce tender procurement for hospitals
6. In-depth analysis on generic medicines pricing should be undertaken in order to avoid

that generic medicines are sold based on the selling price of innovator brand and not
based on actual manufacturing cost.
7. A system for continuous monitoring of prices which must also ensure transparency
should be established.
8. In September 2004, Indonesian Parliament has enacted the National Social Security
Law in which national social health insurance program is one of the five social
security programs. This Law opens an avenue to link national prepaid financing
scheme with national drug policy. The Law can strengthen generic competition and
medicine pricing formula indirectly through setting up drug formularies guaranteed
by the national social health insurance program. The result of this study can be used
for discussion on developing drug formularies for the implementation of the national
social health insurance program.
1. Introduction and Background

During the months of August and November 2004, a field study was conducted to measure
medicine prices in six provinces in Indonesia. The goal of the study was to draw on price
monitoring and cross-country comparison to find reliable information on medicine prices in
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order to develop a sound medicine pricing policy and to secure peoples access to affordable
medicines. The field work was carried out by using WHO/HAI methodology for the
collection, analysis and interpretation of medicine prices in a standardized way. It endeavors
to shed light on six questions:
1. What prices do people pay for key medicines?
2. Do the prices and availability of the same medicines vary in different sectors: public
pharmacies, private pharmacies and other outlets?
3. What is the difference in prices of innovator brands and generically equivalent
medicines?
4. How do procurement prices compare with international reference prices and with local
retail prices?
5. How affordable are medicines for ordinary people?
Country Data
Geography, population, administrative structure and macro economy

Indonesia is an archipelagic country of over 17,000 islands occupying a total area of 5.2
million km2 (1.9 million km2 land area and 3.3 million km2 ocean areas) and lying between
Pacific and Indian Oceans. The estimated population in 2002 was 211.1 million. The
population growth rate has declined in the last two decades, in which the annual average
growth rate was 1.98 percent in year 1980-1990 and 1.49 percent in year 1990-2000. This
figure was projected to decline further to 1.25 percent in 2002. Indonesia has a characteristic
of geographical imbalance in population distribution. 59 percent of the countrys populations
are in Java Island, which covers only 7 percent of the total area of Indonesia. It makes the
population density of Java higher than that of other islands. The average population density
in the year 2002 was 112 population/km2 and 44 percent of inhabitants lived in urban areas1.
Central Bureau of Statistics, National Family Planning Coordinating Board, Ministry of Health, and ORC
Macro. Indonesia Demographic Health Survey 2002-2003.
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Indonesia is a unitary state, in which administratively divided into provinces and each
province is subdivided into regencies and municipalities. Altogether, there are 33 provinces,
302 regencies and 89 municipalities. The next lower administrative units are sub districts and
villages which are consisted of 4,918 and 70,460 respectively1.
Indonesia has faced the outbreak of the economic crisis since 1997 changing its feature as
one of East Asias miracle economies. Indonesia is the only crisis-hit country in Asia which
has not felled back to its pre-crisis level of growth. Currently the economic growth is around
4%, while it was 7% or 8% in early 1990s. In 1998, Indonesia went through its worst
economic crisis, the growth dropped to negative 13%. Income per capita decreased from
US$ 1,100 in 1996 to approximately US$ 700 in 2000. Open unemployment increased from
4.7% in 1997 to 9.1% in 2002 and unemployment was around 24% in 2002. As a result,
poverty rose steeply, reaching 23% in 1999 but in 2002 the level fell back to 18% - 38 million
people1,2.
Health system and pharmaceutical regulation

Indonesian health system is characterized by heavily relying on private sources, market
oriented and profit-motivated. It is mainly because public investment in health is very low.
The public expenditure on health in 2000 was only 0.6% of GDP or 20% of total health
expenditure, which was US$ 7.6 per capita annually. These figures were substantially below
the average for low and middle income countries (2.5% of GDP, 47.2% of total health
expenditure, and US$ 34.9)2. This low public expenditure left the private sector responsible
for around 80% of total health expenditure. This spending was dependent on household
budget as public health insurance system remains underdeveloped and its coverage was only
around 20.2% of population3.
The low government spending led to prioritizing of health development to the primary
healthcare system. An integrated public health service at primary level are available in all
districts up to village level and the spending is fairly distributed across social classes.2 In
2
Central Bureau of Statistics, National Development Planning Agency, United Nation Development
Programs. Indonesia Human Development Report, 2004.
3
National Health Survey, 2002
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contrast, the private primary care and both public and private secondary and tertiary care
(specialties and hospitalization) are mostly financed by out-of-pocket expenditures through
fee-for-service payment model. As a result market and profit-motivated performance guide
the health care services.
At present, the mechanism of medicines price control in Indonesia is mainly focused on
public health sector for procurement of essential generic medicines for primary healthcare
centers4, vertical public health programs5 and social safety net program (health insurance for
the poor)6, 153 un-branded generic medicines for public & private sector have prices
controlled by the government. Regrettably to say, the use of these medicines is less popular
in private sectors. There is no government regulation of medicine prices for the rest of the
216 medicines on the National Essential Medicines List for private sector and no regulation
of prices of branded medicines. As a result, market plays an important role in medicine
pricing for unregulated medicines in Indonesia. This lack of regulation of prices of medicines
affects the affordability and availability of medicines, which are factors influencing peoples
access to essential medicines.
Ministerial Health Order nr. 639 of 2003 on General Guideline for Drug Procurement for Public Primary
Healthcare Center.
5
Ministerial Health Order nr. 638 of 2003 on General Guideline for Drug Procurement for Vertical Health
Program.
6
Ministerial Health Order nr. 56 of 2005 on Guidelines for Health Insurance for the Poor
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2. Methods
Study design
This study was cross-sectional to provide a comprehensive picture of prices of selected
medicines in six regions in four regions in Indonesia by using WHO/HAI methodology.
The study took place in one municipality and one district in every selected province. One
municipal administrative area of capital of each province was selected to represent urbanized
area, while one district administrative area of each province represented less urbanized area.
The districts or municipalities were selected based on the availability of all levels of health
care and the distance of district from the province capital. In each province, up to 20 outlets
were surveyed
Some basic information on the pharmaceutical sector is attached as Annex 1.
Study sites
The study was conducted in four regions representing Western part of Indonesia (I), Capital
region and Java Island (II), Central part of Indonesia (III), and Eastern part of Indonesia
(IV), see Figure 1. Six provinces in those regions were included, see table 1. These groups
were selected based on the distance of each region from Jakarta.
Table 1. Study locations
REGION
I
II
III
IV
PROVINCE
Sumatra Selatan
DKI Jakarta
Jawa Timur
Sulawesi Selatan
Kalimantan Selatan
Papua
MUNICIPALITY
Palembang
Jakarta Pusat
Jakarta Timur
Surabaya
Makasar
Banjarmasin
Jayapura
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DISTRICT
Lubuk Linggau
Bondowoso
Gowa
Martapura
Timika
Figure 1: Study Sites
I
IV
III
II
Sample selection
In each location except Jakarta, which is entirely urban, outlets were selected according to
the WHO/HAI guidance within the municipality containing the provincial headquarters and
an adjacent rural district. This area generally contains a provincial hospital, two district
hospitals and a large number of health centers, from which a total of 5 public facilities were
selected. Health center outlets were deliberately under-represented, because in Indonesia
health centers levy a flat fee for a consultation and drugs dispensed from the district
government units. At least 5 private pharmacies were selected on the basis of proximity to
these public sector facilities. Because religious foundations manage many private hospitals in
Indonesia, the data collected from these NGO hospitals are grouped together with private
hospitals; up to 5 (private and NGO hospitals) in each province were selected by proximity
to the public facilities already chosen. Up to 5 other outlets, including dispensing doctors
and registered drugs stores were selected. The drug stores were later deleted from the
analysis.
The central medicine procurement and public medicine stores are at district level and
managed by District Health Offices. The medicines are distributed to public primary
healthcare centers within the district and finally to the patients at no charge or for a fixed fee
per visit. Moreover, after health sector decentralization came into effect in 2000, local
governments are allowed to purchase medicines for their public primary healthcare centers
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and to expand the list of items and products. In some areas, especially in big cities, public
primary healthcare centers extend their curative services by also providing private services.
Therefore, the centers purchase some additional medicines not included in the government
list or branded generic equivalent medicines, which have higher cost than those in the
government list. In this case, prices that patients pay are net procurement prices without any
additional charges such as handling cost.
The public sector patient prices were gathered from pharmacies within the public hospitals.
Public hospitals are not part of central procurement and purchase from distributors /
wholesalers. In Indonesia, public hospitals are allowed to collaborate with or set up private
pharmacies on their premises, these private pharmacies in public hospitals were categorized
as private sector and are included in the private sector.
Medicines selection
Twenty-six medicines from the WHO/HAI core list were selected as the basis for data
collection and analysis. A list of 16 supplementary medicines was added, making the full list
42. Prices were collected for all these, but as 9 did not have a reference price in the source
used, see below, these 9 were deleted from the analysis part and will be analysed separately as
a component of a TRIPS study. Thus 7 supplementary medicines are included in this report:
5 medicines from the WHO/Trips template and WHO-Jakarta recommendation, 1 medicine
that had a different strength from the one on the core list (fluconazole), and 1 medicine with
high utilization rate (amoxicillin 500mg). In total 42 medicines were surveyed and 33
analysed.
Indonesia has a list of total 369 essential medicines (EML), 153 of these are non-branded
generics under price control, see Annex 2. The list varies by level of healthcare. 13 of these
153 are among the 33 surveyed in hospitals: aciclovir, amitriptyline, amoxicillin 250mg and
500mg,
captopril,
ciprofloxacin,
diazepam,
erythromycin,
glibenclamide,
hydrochlorothiazide, metformin, pyrimethamine+sulfadoxine, ranitidine. Eight of these are

also on the primary healthcare EML (amitriptyline, amoxicillin 500mg, captopril, diazepam,
erythromycin, glibenclamide, hydrochlorothiazide, pyrimethamine+sulfadoxine).
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Prices were recorded for three categories of each substance: the innovator brand (IB), the
most sold generic equivalent (MSG) and the lowest price generic equivalent (LPG). All
medicines included in the survey has market authorization in Indonesia. The International
Medical Statistics (IMS) of Indonesias Total Market Audit in 2003 was the basis for
developing the list and for determining the most sold generic equivalents in the country. The
detailed list of medicines is attached as Annex 3.
Study Personnel
The study involved various institutes in Jakarta and the five other selected provinces as
follows:
-
National Institute of Health Research and Development (Host Institute)
Directorate of Pharmacy and Medical Devices, Ministry of Health (Collaborator and

Local Investigator)
National Agency of Food and Drug Control (Collaborator)
Management Science for Health Indonesia (Collaborator)
Indonesian Pharmaceutical Association (Collaborator)
WHO Indonesia Office (Collaborator)
Provincial Health Offices 6 provinces (Collaborator)
District Health Offices 12 districts (Collaborator and local investigator)
Ethical Considerations
Permission to undertake this survey was obtained from the Ministry of Health, National
Agency for Food and Drug Control, and Local Governments (Provincial Health Offices and
District Health Offices). Before initiating data collection, written Informed Consent from
the directors of hospitals, retail pharmacies, clinics, and doctors participating in the study
were requested. Participant confidentiality in publications and reports during and following
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completion of the survey, is ensured. Each health care facility was given a number to ensure
anonymity. Access to both electronic and hard copy data is restricted to authorized principal
investigator and senior study personnel only.
Pre-survey seminar
A pre-survey seminar was held in Ministry of Health, Jakarta on 23 June 2004
in
collaboration with WHO-Indonesia prior to field survey. The objectives of this seminar
were: 1) to discuss the current medicine prices and policy; 2) to raise awareness and support
from government and other institutions in conducting a study on medicine prices; 3) to
discuss medicines included in the survey and field preparation. A wide range of participants
came from various institutions representing national governments (Ministry of Health,
Ministry of Finance, National Agency for Food and Drug, Patent Office of Ministry of Law),
local government participants in the survey (6 provinces), Research Institutions and
university, Non-Governmental Organizations (Consumer Group of Indonesia, Indonesia
Medical Association, Indonesia Pharmaceutical Association, Indonesia Hospital Association,
Indonesia Pharmaceutical Watch), representative of the Association for Pharmaceutical
Industry, and Parastatal Health Insurance Companies (Askes and Jamsostek). The seminar
provided strong support to the survey.
Training
A two-days workshop in Jakarta was held to train data collectors in ensuring the reliability
and reproducibility of the survey.
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3. Data Collection and Analysis

Data collection
A standardized data collection form was developed and pre-tested as part of the training
prior to field survey. The form is attached as Annex 4. The 9 medicines not analysed are
highlighted by shaded rows.
The survey team consisted of researchers from National Institute of Health Research and
Development (NIHRD)-MOH and health representatives from the six provinces. Each
province had one supervisor from NIHRD and two enumerators from the province. Field
preparation was initiated by holding a local meeting in Provincial Health Offices and District
Health Offices and it continued by selecting outlets to be surveyed and collecting informed
consent by the directors of the outlets. The outlets were visited following the schedule
arrangement done during the field preparation.
Price data were collected from three different sectors covering public, private for-profit and
other sectors. Included were 16 public primary healthcare centers (procurement prices), 15
pharmacies in public hospitals (public patient prices), 58 private for-profit institutions (retail
pharmacies and private pharmacies in private, NGO and public hospitals) and 11 dispensing
doctors.
Data Entry and Analysis
Data entry and analysis were done by the researchers from NIHRD. As mentioned above, 33
of the 42 medicines surveyed has been analysed.
The proposed methodology for identifying components of medicine prices was redesigned
during the course of study and collection has since been done as a separate exercise and
published as a separate report which is not included here.
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The analysis calculated prices for medicines found in 4 or more outlets and used median
prices for individual products. This was converted into a ratio (MPR) for each medicine by
dividing the median price by its international reference price (IRP), see below. A summary of
the MPRs of all medicines are automatically calculated. The size of the difference between
the price representing 25% of the median price and the price representing 75% of the
median price is used to indicate the price variability between facilities. The median price is
also used to examine key aspects of treatment affordability. The analysis of availability is
based on medicines found in 1 or more outlets.
International reference prices (IRP)
International reference prices are used in the WHO/HAI methodology to facilitate national
and international price comparisons. Management Sciences for Health (MSH) 2003 median
supplier unit prices were used as the reference for this survey (see MSH International Price
Guide Indicator at http://erc.msh.org ). Where no supplier prices were available, median
agency unit prices were used. MSH prices represent recent procurement prices offered by
not-for-profit and for-profit suppliers to developing countries for generically equivalent
products. These suppliers sell in large quantities to governments and NGOs so the prices
tend to be low.
Median price ratio (MPR)
The data from the survey are not presented in rupiah but as median price ratios (MPRs)
calculated using international reference prices. The median price ratio is the median local
cost (in rupiah) divided by the reference median unit price (converted to rupiah using the
exchange rate on the first day of data collection i.e. 1 USD = 8 860 rupiah).
The ratio describes how much greater or smaller the local medicine price is to the
international reference price, e.g. an MPR of 5 means that the local medicine price is five
times the international reference price. Median price ratios facilitate comparisons in medicine
price surveys, in particular between countries.
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WHO and HAI consider an MPR 1 to indicate that procurement for public sector is
efficient and an MPR 2.5 to be acceptable in the private sector. Larger price ratios are
considered excessive.
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4. Results
The following analyses will be presented:
4.1 Availability of the medicines in the different sectors on the day of data collection
4.2 Public sector procurement prices
4.3 Public sector patient prices and availability
4.4 Private for-profit sector patient prices and availability
4.5 Medicine prices and availability in the other sector
4.6 Price variation across sectors
4.7 Private for-profit patient prices and availability across regions
4.8 Treatment affordability
4.9 National prices in an international perspective
The report also highlight differences between the prices of innovator brand medicines,
nationally most sold generic equivalents (branded and non-branded), and lowest price
generic equivalents in the facilities monitored. The reason for measuring both the most sold
and the cheapest generic equivalents is to highlight any significant differences between what
people would have paid if the lowest price generic equivalent had been prescribed and what
they pay for the most popular generic.
4.1 Availability of the medicines on the day of data collection
Table 2. Number of products found in 4 facilities
Medicine type
Public
Procurement
Innovator Brand (IB)

Most Sold Generic Equivalent (MSG)
Lowest Price Generic Equivalent (LPG)
0
4
15
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Public
sector
3
13
23
Private
sector
25
22
26
Other
sector
0
1
6
Table 2 shows that the most sold and the lowest price generic equivalents are more widely
available in all sectors, except in private for-profit sector, than innovator brands. Dispensing
doctors (other sector) had few of the surveyed medicines.
To list numbers only does not give good information about the situation because individual
medicines have different importance, e.g. it is vital that medicines on the Indonesian
Essential Medicines List (EML) are available. A full list of availability for individual
medicines is included as Annex 5. In the following results of more in depth analysis will be
shown.
4.2 Public sector procurement prices
Table 3 Median MPRs for public sector procurement prices
Number of
medicines in
4 tenders
Innovator brand
Most sold generic equivalent
Lowest price generic equivalent
0
4
15
Median
MPR
25%ile
MPR
1.44
1.74
1.16
1.43
75%ile
MPR
2.24
3.38
Procurement prices were collected from 16 primary healthcare centers. 15 of the 33

medicines surveyed were found in at least four places. Median MPR for most sold generic,
only 4 was found, was 1.44 with relatively wide variation in price between institutions.
Median MPR for the 15 lowest price generics found in more than 4 institutions was 1.74,
with even larger variation (3-fold). All the 8 medicines from the EML were found in at least
4 facilities.
Table 4 Median price ratios public sector procurement, lowest price generic examples
Medicine
MPR for LPG
Ciprofloxacin
6.34
Diazepam
1.11
Glibenclamide
4.56
Ranitidine
8.43
For some of the medicines, MPR of the cheapest generic was as high as 4-8 times the
IRP. Diazepam and glibenclamide are from the EML.
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4.3 Public sector patient prices and availability

Table5. Summary of price ratios in public sector for lowest price generic medicines
Procurement
primary
healthcare
Median of the lowest

price generic MPRs
Price to patients
public hospitals
1.74
2.54
The median of the MPRs of prices charged to patients (2.54) compared with the median of
the MPRs of the government regulated prices for public primary healthcare (1.74) indicates
that the average mark-up and taxes in the public hospital pharmacies amounts to around
46%. It must be noted that the procurement prices were collected in primary healthcare
centers, patient prices were collected in public hospital pharmacies where the procurements
were done by the hospitals themselves.
Table 6. Median MPRs in public sector pharmacies
Medicine type
Innovator brand
Most sold
Lowest price
No. of
substances
found
3
13
23
Median MPRs
Median
MPR
25%ile
21.80
5.51
2.54
13.98
1.69
1.73
75%ile
36.47
7.27
5.77
In the public hospitals as representatives of public sector, for the 33 medicines in the survey,
3 innovator brand products (IB), 13 most sold (MSG) and 23 lowest price generic
equivalents (LPG) were found in at least 4 facilities. A full list of MPRs for public sector
patient prices can be found in Annex 6. The MPRs of the LPGs of the 13 medicines from
the EML are from 0.70 (hydrochlorothiazide) to 2.70 (pyrimethamine+sulfadoxine) except
for ranitidine (3.40) and diazepam (5.51).
The median MPR of the 3 innovator brand products found in at least 4 facilities in 15 public
hospitals surveyed was 21.80 times the median IRP but was quite variable with 51.13
(amlodipine), 21.80 (captopril) and 6.15 (metformin), respectively. Meanwhile, on average,
the MSGs and LPGs were much less expensive, but the prices relative to the IRP were still
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high and varied across medicines. The median MPR of the MSGs was 5.51 times the median
IRP, with 50% of the medicines being sold in the range of 1.69 to 7.27 times the IRP.
Meanwhile, the median MPR of the LPGs was 2.54 times the median IRP, with 50% of the
medicines being sold in the range of 1.73 to 5.77 times the IRP. When comparing the prices
of all medicines available in public sector, the cheapest and most expensive items were found
to be 0.7 times (hydrochlorothiazide LPG) and 51 times (amlodipine IB) their IRPs
respectively. Amlodipine LPG was as high as nearly 46, atenolol LPG was nearly 19 and
phenytoin LPG 21.5.
Comparing matched pairs of medicines
In table 6 above, the analysis is based on all medicines found regardless of the different
number found for the three presentations. When matching pairs of medicines are compared
(i.e. the same medicine in the different forms) we get more reliable data.
Table 7. Summary of median MPRs for matched pairs of medicines found in public
sector pharmacies
IB
(n=1)
Median MPR
21.80
MSG
(n=1)
IB
(n=3)
1.69
21.80
LPG
(n=3)
2.54
MSG
(n=13)
5.51
LPG
(n=13)
2.15
Table 7 shows that in the matched pair comparison the IBs were almost 8 times more
expensive than the corresponding MSGs and 12 times more expensive than the
corresponding LPGs. Buying the LPGs will save more than twice compared to the MSGs
(5.51 versus 2.15).
Availability of surveyed medicines in public sector on the day of data collection
Table 8 Availability of generics (LPG) in public pharmacies
Availability
No pharmacies
1-24 %
25-49 %
50-79 %
Medicine
Beclometasone inhaler, fluphenazine inj, lisinopril, nifedipine retard,
salbutamol inhaler, stavudine, zidovudine
Fluconazole, fluoxetine, lovastatin
Atenolol, erythromycin, losartan, metformin, phenytoin,
pyrimethamine+sulfadoxine, simvastatin
Aciclovir, amitriptyline, amlodipine, amoxicillin, carbamazepine,
ceftriaxone inj, co-trimoxazole susp, diclofenac, glibenclamide, losartan,
- 21 -
80 % and over
metformin, omeprazole
amoxicillin 500, captopril, ciprofloxacin, diazepam, hydrochlorothiazide,
ranitidine
Only 6 out of the 33 medicines surveyed were widely available ( 80%) as cheap generics in
public sector pharmacies. About half (18) were found in at least 50% of the public sector
pharmacies. Three of the EMLs were found in less than half the pharmacies. See also Annex
5.
Private sector patient prices and availability
Table 9. Summary of median MPRs in private sector
Medicine type
Innovator brand
Most sold
Lowest price
No. of
substances
found
25
22
26
Median MPR
Median
MPR
22.78
6.74
2.78
25%ile
10.75
2.23
1.92
75%ile
54.10
9.69
8.06
In the private for-profit sector, innovator brands (IB) were more widely available than in
public sector. The prices were high compared to the international reference prices (IRP), the
25 IBs were found to be priced at 22.78 times the IRPs, while MSGs and LPGs were much
less expensive, 6.74 and 2.78 times higher than the IRP respectively. The range of prices was
also wide, 50 % of IBs, MSGs and LPGs were being sold in the range of 10.75 to 54.10, 2.23
to 9.69 and 1.92 to 8.06 times their IRPs respectively.
For a number of medicines, as shown in Annex 6 , there are large differences in price when
comparing IBs with the MSGs or the LPGs. Some of the MSGs were half the price of the
IBs but in other cases, the price difference was as high as 10 to 15 times. It is noteworthy
that IB diazepam cost 100 times the IRP, the MSG 54 times and the LPG only 7 times. For
amlodipine, even LPG is 50 times the IRP, and for the old medicine atenolol the IB is 75
times the IRP, generics are 21 times the IRP (see table 10 below).
- 22 -
Table 10. Median price ratios (MPRs) for individual medicines, private retail
pharmacies - examples
Innovator Brand
53.26
75.07
90.08
101.96
79.45
Amlodipine
Atenolol
Ciprofloxacin
Diazepam
Glibenclamide
Most Sold Generic

N/A
21.32
42.22
53.66
5.59
Lowest Price Generic

49.43
20.44
7.78
6.77
5.74
Comparing matched pairs of medicines

In table 9 above, the analysis is based on all medicines found regardless of the different
numbers found for the three presentations. When matching pairs of medicines are
compared (i.e. the same medicine in the different forms) we get more reliable data on
differences.
Table 11. Summary of median MPRs for matched pairs of medicines found in private
sector pharmacies
Median MPR
IB
(n=17)
MSG
(n=17)
IB
(n=21)
LPG
(n=21)
MSG
(n=22)
LPG
(n=22)
22.78
6.64
25.89
2.75
6.74
2.59
Table 11 shows that in the matched pair comparison the IBs were around 4 times more
expensive than the corresponding MSGs and 9 times more expensive than the
corresponding LPGs. Buying the LPGs will save more than twice compared to the MSGs
(6.74 versus 2.75).
Availability of surveyed medicines in private sector on the day of data collection
Table 12 Availability of generics (LPG) in private pharmacies
Availability
No pharmacies
1-24 %
25-49 %
50-79 %
Medicine
Beclometasone inhaler, fluphenazine inj, lisinopril, nifedipine retard,
salbutamol inhaler, stavudine, zidovudine
fluconazole
Fluoxetine, lovastatin, pyrimethamine+sulfadoxine, simvastatin
Amitriptyline, amlodipine, atenolol, carbamazepine, ceftriaxone inj, cotrimoxazole susp, diclofenac, erythromycin, losartan, metformin,
phenytoin
- 23 -
80 % and over
Aciclovir, amoxicillin 250mg, amoxicillin 500mg, captopril, ciprofloxacin,

diazepam, glibenclamide, hydrochlorothiazide, omeprazole, ranitidine
Only 10 out of the 33 medicines surveyed were widely available ( 80%) as cheap generics in
private pharmacies. 21 of the 33 were available in more than half of the pharmacies. Only
one EML was found in less than half. See also Annex 5.
Medicine prices and availability in the other sector
Table 13. Summary of medicines availability and median price ratios in other sector
Medicine type
Innovator brand
Most sold
Lowest price
No. of
substances
found
Median MPR
Median
MPR
0
1
6
25%ile
75%ile
0.77
1.50
0.77
2.56
0.77
1.91
The other sector is dispensing doctors. The MPR of the MSG found, hydrochlorothiazide,
was 0.77 which is very low. The median MPR of the 6 lowest price generics found was 1.91.
Only 6 LPGs and 1 MSG were found. In Indonesia, doctors are not allowed to dispense
medicines, but in fact several of them are still doing so with a limited number of medicines.
4.6 Price Variation Across Sectors
Table 14. Median Price Ratios for medicines found in the different sectors
Medicine type
Innovator brand
Most sold
Lowest price
Procurement
Public sector
1.44
1.74
21.80
5.51
2.54
Private sector
22.78
6.74
2.78
Innovator brands are very expensive in Indonesia, the median MPR in private sector was
around 22 times higher than the median IRP. The prices of IBs were slightly lower in public
sector, but the sample was small and can be biased. The prices of the MSGs in public
procurement were almost three times lower than the prices in public and private
pharmacies, the difference is smaller for LPGs. The median MPR of the MSGs was around 6
- 24 -
times the median IRP in both the public and private pharmacies. The LPGs are about 10
times cheaper than IBs. There are small differences between public and private sectors.
Annex 6 illustrate the situation for individual medicines. The data reveals small price
differences in the two sectors.
4.7. Price variation across regions - private sector
Table 15 and figure 2 show the median MPRs of medicines per region in public and private
sector respectively. All individual ratios are attached as Annex. 7.
Table 15. Summary of median MPRs for medicines found in public sector, by regions
Regions
Innovator
brand
I
II
III
IV
Median MPRs
Most Sold
Lowest Price
51.23
-
2.81
5.68
-
2.09
3.68
-
For public sector data are so few that no conclusion can be drawn on regional differences,
but the difference between regions II and III indicates that patients in region III has to pay
two times as much as patients in region II.
Figure 2. Summary of median MPRs for medicines found in private sector, by

regions
- 25 -
25
Median MPR
20
IB
15
MSG
10
LPG
5
0
Region I
Region II
Region III
Region IV
Private sector prices show very little variation between regions. To show that this is
independent of different numbers of medicines found in different regions and in different
formulations, the data for captopril is shown in Figure 3.
Figure 3. Median price ratio for captopril in private sector, by region
25
Median MPR
20
IB
15
MSG
10
LPG
5
0
Region I
Region II
Region III
- 26 -
Region IV
4.8 Treatment affordability

The monthly salary of the lowest paid government worker was Rp 20,700.00 which is equal
to USD 2.35 per day. Table 16 illustrates the affordability of treatment in the public and
private sectors for one acute and one chronic condition. A full list of all the treatments
analysed can be found in Annex 8.
Table 16. Cost of treatment for pneumonia and diabetes
Treatment
Type
Public Sector
Median
Days wages
Price (Rp)
Private Sector
Median
Days wages
Price (Rp)
Pneumonia:
Amoxicillin
250 mg x 3 for
7 days
Diabetes:
Glibenclamide
5 mg x 2 for 30
days
Brand
Most sold
Lowest price
31 878
7 455
1.5
0.4
48 720
34 650
7 406,70
2.4
1.7
0.4
Brand
Most sold
Lowest price
12 000
12 000
0.6
0.6
173 160
12 180
12 510
8.4
0.6
06
For a 7-day course of amoxicillin to treat pneumonia, a patient would need to pay the
equivalent of 1.5 days wages of the lowest paid government worker for the most sold
generic and 0.4 days to buy the cheapest generic from public pharmacies. Innovator brand
was not found in public sector. In the private pharmacies, the cost expressed in days wages
would be 2.4 for innovator brand and 1.7 or 0.4 for the two forms of the generic equivalent.
There is little difference in cost between the public and private sectors. This cost refers only
to the medicine component of the total treatment cost. Consultation fees and diagnostic
tests may mean that the total cost to the patient is considerably higher. For a one month
course of glibenclamide to treat diabetes, a patient would need to pay the equivalent of 0.6
days wages for a generic in public sector. Innovator brand was not found. In the private
pharmacies, the cost expressed in days wages would be 8.4 days for innovator brand and 0.6
days for the generically equivalent products. Again no difference between the two sectors.
4.9 National prices in an international perspective
- 27 -
The 2004 medicines price data from countries involved in this study is expected to be
available by the end of this year. Therefore, comparisons of medicines prices for a sample of
medicines in different countries will be undertaken as soon as the data are available on the
HAI website.
- 28 -
5. Discussion
In Indonesia medicine prices are not regulated except for around 150 non-branded generics
in all sectors, the other essential medicines from EML are regulated only for public sector,
particularly for primary health care. In the primary healthcare facilities these medicines will
be free to patients whilst other medicines without controlled prices must be purchased for
the procurement cost. Thus, because not all medicines carry a cost for the patients, patient
prices in public sector was only surveyed in the pharmacies in the public hospitals where
patients have to pay for all medicines.
Our survey of medicine prices in Indonesia shows extremely high prices of innovator brand
products and relatively high prices of the most sold generic equivalents, the cheapest
generics were generally more affordable. Public procurement prices were high and patient
prices differed very little between public and private sectors. Regional variation was minimal.
For most products, the difference between innovator brands and the generically equivalent
products was large, indicating a high brand premium. The differences in price between
innovator brand products and cheapest generic equivalents were found to be as high as 10
times; one item (diazepam) was found to have a median price ratio as high as 101 times that
of the international reference price in private sector. This was 2 times the price of the MSG
and more than 15 times the LPG price.
A summary price ratio of 1.74 in public sector procurement (74% above the international
free on board (FOB) reference price) is a sign that the procurement system in public sector
is not working efficiently. A large country like Indonesia should be able to procure essential
medicines for public sector at prices close to the IRPs (ratio of 1).
Prices in the public hospital pharmacies are high and almost identical to prices in the private
pharmacies. This makes one wonder what the purpose of the public sector pharmacies is. In
general, the innovator brand prices were much higher than the IRPs, but only 3 IBs were
analysed. The median MPR of the IBs was about 2-10 times higher than the median MPR of
the MSGs and, for some medicines the difference was as high as 15 times. The LPGs
- 29 -
median MPR (2.5) was also high compared to the international reference prices used. This
may be caused by what seems to be exorbitant taxes, this has been confirmed in the price
component study.
Prices in private pharmacies were high but surprisingly not higher than in public pharmacies.
Availability was somewhat better, particularly for innovator brands which however, was on
average 22 times the IRP.
High prices of innovator brands are, however, not always a problem. When there are
cheaper generics available and these are being promoted and used, there is no problem. But
if only innovator brands are available, if prescribers and dispensers have incentives to
promote and sell them and in situations where they are patent protected, the high price
makes them inaccessible to patients. The high prices of innovator brands where there are
cheaper generics available, indicates that these manufacturers are not willing to participate in
the competition by reducing their prices.
Some generic medicines have prices close to innovator brand prices. It is probably an
indication that generic medicines prices are based on the price of innovator brands (what
the market can bear) rather than on actual manufacturing cost.
Medicines distribution cost is one of the most influential factors existing in Indonesia, as
most of pharmaceutical industries and importers are located in Jakarta surrounding. In 2003,
national government (Ministry of Health) passed a Ministerial Decree on maximum prices
for a list of essential medicines in public primary health care in four different regions. The
prices include mark-up for transportation and distribution cost which are set at 2.5% in
region 1, 5% in region 2, 7.5% in region 3 and 10% in region 4. However, when comparing
prices paid by patients in both public and private for-profit facilities, the assumption of
higher price for higher transportation and distribution costs in relation to longer distance
from region 1 is not provable as prices were similar in all regions surveyed.
The availability of medicines in public facilities in primary healthcare and in public hospitals
is mainly influenced by the situation that the medicines procured by local governments are
- 30 -
limited to the essential generically equivalent medicines listed in Ministerial Health Decree7;
there were only 8 (eight) medicines from the essential list for Indonesia primary health cares
included in the survey and 13 medicines from the essential list for Indonesia public hospitals.
The low availability of medicines in dispensing doctors sector is mainly due to the nature of
healthcare services which is focused on the first level of healthcare. Solo practice doctors
provide simpler treatments and do not stock higher cost and infrequently required
medicines. The other possible explanation was the design of study, a cross-sectional study
design, a one point in time investigation, which does not take into account the problem of
stock-outs.
Differences in availability between public and private sector was mainly seen for innovator
brands. As mentioned above, this is not a problem where cheaper generics are available.
However, public hospitals also have private pharmacies with more expensive innovator
brands. Whether patients go here or to public pharmacies cannot be concluded from this
survey. It is therefore difficult to say that a national policy on promoting generics is working
so well that the much lower prices of the generically equivalent products minimize the price
barrier for poor people. This pro-people policy needs to be strengthened by conducting prequalifying and quality assurance measurement and by developing a quality-assured
therapeutic substitution policy to improve consumers confidence, and also to employ a costcontainment strategy that affect the full cost of a course of treatment.
Affordability in particular of innovator brands was poor. In the two examples given it would
cost the lowest paid government worker 1.5 days salary to pay for a weeks treatment with
innovator brand amoxicillin for pneumonia and 8.4 days salary to pay for a months
treatment of diabetes with glibenclamide. Both medicines are on the essential medicines list.
In both cases, using cheap generics would cost much less with 0.4 and 0.6 days respectively.
This survey cannot tell what is actually being purchased.
It was beyond the scope of this survey to identify whether generically equivalent products
are cheaper due to lower quality. In this study, all products were registered in Indonesia so
7
Ministerial Health Decree number 639 of 2003 on general guideline of drug procurement in primary
health care in Indonesia.
- 31 -
we assume that they were of acceptable quality. If differences in the quality of medicines is
considered a possible cause of price differences, it could be addressed in any follow up to
this study. There is, however, no link between quality and price, this is also shown by the low
prices of good quality generic medicines used as reference prices in this survey.
The conclusions drawn from this survey are limited by a number of factors. We tried to
identify the most sold generics using prescription statistics, but judging from the low number
found, it seems as if we were not successful. The list of medicines surveyed may not
represent the most frequently prescribed medicines. There may for instance be
therapeutically equivalent substances that are more frequently used in Indonesia. Some
medicines were added from the national list of essential medicines, but more would need to
be surveyed to get a better picture. In the public sector, procurement prices were obtained
from primary healthcare sector where patient prices were not surveyed. In public sector,
several different types of private pharmacies were analysed together and we have not looked
at any differences in price and availability between the facilities because the sample sizes for
each type of facility are not large enough. Finally, to ascertain prices people actually paid can
only be determined by specific studies such as interviewing patients when they leave the
pharmacy (exit survey) or by visiting them at home (household survey). Price components
are discussed in a separate report.
This survey should be used for signal generation. The findings identify some problems with
medicine prices and pricing policies in Indonesia, which should encourage further studies to
describe the situation in more detail.
- 32 -
6. Conclusions and recommendations

The principal conclusions of the study are as follows:
Prices are high compared to international reference prices in public and private
pharmacies and there are large differences between innovator brand and generic
equivalent products.
The prices of generic medicines vary and the cheapest generic equivalent is not always
the most sold.
The availability of medicines in public sector, especially in public procurement, is far

from optimal. This could be due to a restricted list being used in public sector and not
corresponding well with the list of medicines surveyed.
The price difference between what patients pay in public and private sectors are small.
Generics are widely available in all sectors and the prices are much lower than innovator
brand products making treatment more affordable for most people but we do not know
whether they are being promoted and sold as often as they should.
The prices vary little across regions in Indonesia and suggests that distribution and
transportation cost have little influence on final price.
Indonesian public health sector is inefficient in procurement as prices obtained are on

average almost two times the international procurement prices.
On the basis of the findings of the study, the following recommendations are made to the
Ministry of Health Indonesia.
1. For a large country with a diverse healthcare sector such as Indonesia, this survey is
not large enough to draw firm conclusions. Similar surveys should therefore be
conducted by state.
2. An extended survey should be undertaken to ascertain the reasons for the high prices
and the large prices differences between innovator brands and generic equivalent
products.
- 33 -
3. Measures should be taken to lower patient prices in public sector, making public
sector an attractive alternative.
4. A policy favouring the use of generic medicines should be strengthened by
introducing quality assurance to increase professionals and patients confidence.
5. Inefficient public procurement should be elaborated and solved by following possible
approaches:
Competitive tender with price transparency
Use international reference prices as guidelines
Introduce tender procurement for hospitals
6. In-depth analysis on generic medicines pricing should be undertaken in order to avoid

that generic medicines are sold based on the selling price of innovator brand and not
based on actual manufacturing cost.
7. A system for continuous monitoring of prices which must also ensure transparency
should be established.
8. In September 2004, Indonesian Parliament has enacted the National Social Security
Law in which national social health insurance program is one of the five social
security programs. This Law opens an avenue to link national prepaid financing
scheme with national drug policy. The Law can strengthen generic competition and
medicine pricing formula indirectly through setting up drug formularies guaranteed
by the national social health insurance program. The result of this study can be used
for discussion on developing drug formularies for the implementation of the national
social health insurance program.
- 34 -
ANNEX 1
National Pharmaceutical Sector form

Date: September 1, 2004
Population: 220 million
Daily wage of lowest paid government worker: Rp 20,700.00
Rate of exchange (commercial buy rate) to US dollars on the first day of data
collection: 8,860.00
Sources of information: Directorate Pharmaceutical Ministry of Health
General information on the pharmaceutical sector

Is there a formal National Medicines Policy document covering
both the public and private sectors?
Is an Essential Medicines List (EML) available?
> Yes
>Yes
If yes, state total number of medicines on national EML: 369

If yes, year of last revision: 2000
If yes, is it (tick all that apply):
National>
Regional
Public sector only
Both public and private sectors>
Other (please specify):
If yes, is the EML being used (tick all that apply):
For registration of medicines nationally
Public sector procurement only
Insurance and/or reimbursement schemes>
Private sector
Public sector>
Is there a policy for generic prescribing or substitution?

Yes>
Are there incentives for generic prescribing or substitution? Yes>
- 35 -
No
No
No
No
Public procurement8
Is procurement in the public sector limited to a selection of
essential medicines? Yes>
No
If no, please specify if any other limitation is in force:
Type of public sector procurement (tick all that apply):

International, competitive tender
Open
Closed (restricted)
National, competitive tender>
Open
Closed (restricted)
Negotiation/direct purchasing>
Are the products purchased all registered? Yes>

No
Is there a local preference?9
Yes>
No
Are there public health programmes fully implemented by donor Yes No>
assistance which also provide medicines?
(e.g. TB, family planning, etc.)
If yes, please specify: vertical program provided in public primary healthcare are
jointly financed by national government and international donors such as TB and
HIV/AIDS
Distribution10
Is there a public sector distribution centre/warehouse?
Yes>
No
Yes
No>
If yes, specify levels: district level
Are there private not-for-profit distribution centres:

e.g. missions/nongovernmental organizations?
If yes, please specify: National Red Cross,
Number of licensed wholesalers: 2,478
Retail
Number of inhabitants per pharmacy (approx.)
Urban
NA
Rural
NA
Overall
NA
Number of inhabitants per qualified pharmacist
NA
NA
NA
8 If there is a public procurement system, there is usually a limited list of items that can be procured. Products procured on international tenders are sometimes registered in the recipient
country only by generic names. Import permits to named suppliers are issued based on the approved list of tender awards. An open tender is one that is publicly announced; a closed one
is sent to a selection of approved suppliers.
9 A local preference means that local companies will be preferred even if their prices are not the cheapest. Local preference is normally in the range of 1020%.
10 The public sector often has a central storage and distribution centre which may have at least one sublevel. The private not-for-profit sector may be dominated by one
type of NGO (e.g. church missions), but may also comprise others such as Bamako Initiative type projects, Red Cross or Red Crescent Society, Mdecins Sans Frontires.
- 36 -
(approx.)
Number of pharmacies with qualified pharmacists
NA
NA
8,364
Number of medicine outlets with pharmacy

technician
NA
NA
NA
Number of other licensed medicine outlets
NA
NA
NA
Private sector11
Are there independent pharmacies?
Are there chain pharmacies?
Do doctors dispense medicines?12
Yes>
Yes>
Yes>
No
No Number: 8,364
No Number: NA
If yes, approximate coverage or % of doctors who dispense: NA
Are there pharmacies or medicine outlets in health facilities?
Yes>
No
11 Retail outlets may be called pharmacies, medicine outlets, drug stores, chemists, etc. They may be run/owned by a qualified pharmacist (with
diploma) or another category: e.g. pharmacy technician, or a lay person with short training.
12 Many countries allow doctors to dispense and sell medicines.
- 37 -
ANNEX 2
ESSENTIAL MEDICINES LIST
FOR NON BRANDED GENERICS WHICH PRICES ARE FULLY
CONTROLLED BY THE GOVERNMENT IN INDONESIA
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
28
29
30
31
32
33
34
35
36
37
No.
Medicine Name
Aciclovir cream 5%
Aciclovir tablet 200 mg
Aciclovir tablet 400 mg
Albendazole tablet 400 mg
Allupurinol tablet 100 mg
Amiloride tablet 5 mg (HCl)
Aminophylline inj. 24 mg/ml
Aminophylline tablet 200 mg
Amitriptyline coated tablet 25 mg (HCl)
Amoxicillin capsul 250 mg
Amoxicillin powder for syrup 125 mg/5 ml
Amoxicillin tablet 500 mg
Ampicillin powder for inj. i.m/i.v 1000 mg/ml
Ampicillin powder for inj. i.m/i.v 500 mg/ml
Antacid chewing tablet: Al(OH)3 200 mg & Mg(OH)2 200 mg
Antacid suspension : Al(OH)3 200 mg/ml & Mg(OH)2 200 mg/ml
Anti malaria : Pyrimethamine 25 mg & Sulfadoxine 500 mg
Antihemorrhoidal : Bismuth subgallate 150 mg & hexachlorofen 2.5 mg
Anti-Parkinsonism : Carbidopa 25 mg, Levodopa 250 mg
Ascorbid Acid (Vitamin C) tablet 50 mg
Benzatin Benzyl Penicillin 1,200,000 IU/vial
Benzatin Benzyl Penicillin 2,400,000 IU/vial
Betamethasone cream 0.1 mg
Calcium lactate tablet 500 mg
Captopril tablet 12.5 mg
Captopril tablet 25 mg
Chloramphenicol ear drop 3%
Chloramphenicol suspension 125 mg/5 ml
Chloroquine tablet 150 mg
Chlorpheniramine Maleate (CTM) tablet 4 mg
Chlorpromazine coated tablet 100 mg (HCl)
Chlorpromazine coated tablet 25 mg (HCl)
Chlorpromazine inj.25 mg/ml (HCl)
Chlorpromazine inj.5 mg/ml (HCl)
Ciprofloxacin tablet 500 mg (as HCl)
Cotrimoxazole adult : Sulfametoxazole 400 mg & trimethoprim 80 mg
Medicine Name
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
No.
Cyanocobalamin (vitamin B12) inj. 500 mcg

Dexamethasone inj. i.v. 5 mg/ml
Dexamethasone tablet 0.5 mg
Dextrometorphan syrup 10 mg/ml (HBr)
Dextrometorphan tablet 15 mg(HBr)
Dextrose infusion solution 10 %
Dextrose infusion solution 5 %
Diazepam inj. 5 mg/ml
Diazepam tablet 2 mg
Diazepam tablet 5 mg
Dicloxacillin capsule 250 mg
Digoxin tablet 0.25 mg
Diltiazem HCl tablet 30 mg
Dimenhydrinate tablet 50 mg
Diphenhydramine inj. i.m. 10 mg/ml (HCl)
Doxycycline capsule 100 mg
Ephedrine tablet 25 mg (HCl.)
Epinephrine (Adrenalin) inj. 0.1% (as HCl)
Erythromycin capsule 250 mg
Erythromycin capsule 500 mg
Ethambutol coated tablet 500 mg (HCl.)
Ethambutol tablet 250 mg (HCl.)
Extract Belladonna tablet 10 mg
Fluor tablet 0.5 mg
Folic Acid tablet 1 mg
Furosemide inj. i.v/i.m 10 mg/ml
Furosemide tablet 40 mg
Gentamycin inj. 80 mg/ml
Gentamycin skin ointment
Glibenclamide tablet 5 mg
Glyseryl guaicolat tablet 100 mg
Griseofulvin tablet 125 mg, micronized
Haloperidol tablet 0.5 mg
Haloperidol tablet 1.5 mg
Haloperidol tablet 5 mg
Hydrochlorotiazide tablet 25 mg
Hydrocortisone cream 2% (acetate)
Ibuprofen tablet 200 mg
Ibuprofen tablet 400 mg
Isoniazide tablet 100 mg.
Isoniazide tablet 300 mg.
Isosorbid dinitrate sublingual tablet 5 mg
Medicine Name
- 39 -
83
84
85
86
87
88
89
90
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
No.
Lidocaine inj.2% (HCl) + Epinephrine 1 : 80.000 2ml

Lidocaine inj.2% (HCl)
Mebendazole tablet 100 mg
Metformin coated tablet 500 mg
Methampyrone tablet 250 mg
Methampyrone tablet 500 mg
Methyl ergometrine coated tablet 125 mg (maleat)
Metronidazole tablet 500 mg
Miconazole cream/ointment 2% (nitrat)
Na.bicarbonate tablet 500 mg
Na.thiosulfat inj. I.V 50 mg/ml (HCl)
NACl infusion solution 0.9%
Nifedipine tablet 10 mg
Nystatin coated tablet 500.000 IU/g
Nystatin vaginal tablet 100.000 IU/g
Oralit powder : NaCl 0.7 g, KCl 0.3 g & Na.Citrate 0.58 mg
Oxytetracycline inj. I.V 50 mg/ml (HCl)
Oxytetracycline zalp mata 1% (HCl)
Paracetamol syrup 120 mg/ml
Paracetamol tablet 500 mg
Paracetamol tablet 500 mg
Perphenazine tablet 4 mg (HCl)
Phenobarbital inj.i.m/i.v.50 mg/ml
Phenobarbital tablet 30 mg
Phenoxymethylpenicillin tablet 500 mg
Phenoxymethylpenicillin tablet 500 mg
Phenylbutazone tablet 200 mg
Phytomenadione (vitamin K) coated tablet 10 mg
Phytomenadione (vitamin K) inj.10 mg/ml
Pilocarpine eye drops 2% (HCL/nitrat)
Povidon-iodine solution 10%
Praziquantel tablet 600 mg
Prazosin tablet 1 mg (HCl)
Prednisone tablet 5 mg
Primaquin tablet 15 mg
Procain Benzylpenicillin G inj. 3 jt IU/vial
Propranolol tablet 10 mg (HCl)
Propranolol tablet 40 mg (HCl)
Propylthiouracil (PTU) 100 mg
Pyrantel tablet score (base) 125 mg
Pyrazinamide tablet 500 mg
Pyridoxine (vitamin B6) tablet 10 mg
Medicine Name
127
Quinine tablet 22 mg (H2SO4.7H2O)

- 40 -
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
Ranitidine tablet 150 mg

Reserpine tablet 0.10 mg
Reserpine tablet 0.25 mg
Retinol (Vitamin A) 100.000 IU soft capsule
Retinol (Vitamin A) 200.000 IU soft capsule
Retinol (Vitamin A) tablet 50.000 IU
Rifampicin capsule 300 mg
Rifampicin capsule 600 mg
Rifampicin coated tablet 450 mg
Ringer-lactate infusion solution
Salbutamol tablet 2 mg ( as Sulfas)
Salbutamol tablet 4 mg ( as Sulfas)
Salicylic Acid tablet 100 mg (Acetosal)
Salicylic Acid tablet 500 mg (Acetosal)
Streptomycin powder inj. i.v. 1500 mg/ml
Sulfadimidine tablet 500 mg
Atropin sulphate eyedrops 0.5 %
Atropin sulphate inj. i.m/i.v/s.c 0.25 mg/ml
Ferrous sulphate coated tablet 300 mg
Tetracycline capsule 250 mg
Tetracycline capsule 500 mg
Thiamine (Vitamin B1) inj. 100 mg/ml
Thiamine (Vitamin B1) tablet. 50 mg/ml (HCL/NO3)
Trihexyphenidyl tablet 2 mg
Verapamil tablet 80 mg (HCl)
Vitamin B complex tablet
- 41 -
ANNEX 3
List of medicines included in Indonesia medicines survey
Generic name
Aciclovir
Amitriptyline
Amlodipine
Amoxicillin
Amoxicillin
Atenolol
Atorvastatin
Azithromycin
Beclometasone
Candesartan
Captopril
Carbamazepine
Ceftriaxone
Celecoxib
Ciprofloxacin
Co-trimoxazole
Diazepam
Diclofenac
Erythromycin
Esomeprazole
Fluconazole
Fluoxetine
Fluphenazine
decanoate
Ganciclovir
Glibenclamide
Hydrochlorothiazide
Lisinopril
Losartan
Lovastatin
Metformin
Nifedipine Retard
Ofloxacin
Olanzapine
Omeprazole
Phenytoin
Pyrimethamine with
sulfadoxine
Ranitidine
Risperidone
Salbutamol
Simvastatin
Stavudine
Zidovudine
Strength
Form
Category
antiviral
antidepressant
antihypertensive
antibacterial
antibacterial
antihypertensive
antihyperlipidaemic
antibacterial
corticosteroid
antihypertensive
antihypertensive
antiepileptic
antibacterial
anti-inflammatory
antibacterial
antibacterial
Core
list?
yes
yes
no
yes
no
yes
no
no
yes
no
yes
yes
yes
no
yes
yes
Innovator
brand
Zovirax
Tryptizol
Norvask
Amoxil
Amoxil
Tenormin
Lipitor
Zithromax
Becotide
Blopress
Capoten
Tegretol
Rocephin
Celebrex
Ciproxin
Bactrim
Most sold
generic
Acyclovir
Amitriptilyn
Tensivask
Amoxan
Amoxan
Betablok
Zistic
Cleril
Captopril
Carbamazepin
Terfacef
Baquinor
Cotrimoxazole
200 mg
25 mg
5 mg
250 mg
500 mg
50 mg
10 mg
500 mg
50 mcg/ dose
8 mg
25 mg
200 mg
1 g/vial
200 mg
500 mg
(8+40)
mg/ml
5 mg
25 mg
250 mg
20 mg
150 mg
20 mg
25 mg/ml
tablet
tablet
tab/cap
tab/cap
tab/cap
tablet
tab/cap
tab/cap
inhaler
tab/cap
tablet
tablet
injection
tab/cap
tablet
suspensi
on
tablet
tablet
tab/cap
tab/cap
tab/cap
tab/cap
injection
sedative/hypnotic
anti-inflammatory
antibacterial
antisecretory
antifungal
antidepressant
major tranquilliser
yes
yes
no
no
no
yes
yes
Valium
Voltaren
Erytrocyn
Nexium
Diflucan
Prozac
Modecate
Stesolid
Voltadex
Erythromycin
Zemyc
Kalxetin
-
500 mg
5 mg
25 mg
20 mg
50 mg
20 mg
500 mg
20 mg
200 mg
5 mg
20 mg
100 mg
(25+500) mg
injection
tablet
tablet
tab/cap
tablet
tablet
tablet
tablet
tab/cap
tab/cap
capsule
tab/cap
tablet
Antiviral
antidiabetic
antihypertensive
antihypertensive
antihypertensive
antihyperlipidaemic
antidiabetic
antihypertensive
antibacterial
major tranquilliser
antisecretory
antiepileptic
antimalaria
no
yes
yes
no
yes
yes
yes
yes
no
no
yes
yes
yes
Cymevene
Daonil
Dichlotride
Zestril
Cozaar
Mevacor
Glucophage
Adalat Retard
Tarivid
Zyprexa
Losec
Epanutin
Fansidar
tablet
tab/cap
inhaler
tab/cap
tab/cap
capsule
antisecretory
major tranquilliser
bronchodilator
antihyperlipidaemic
antiretroviral
antiretroviral
yes
no
yes
no
no
yes
Zantac
Risperdal
Ventoline
Zokor
Zerit
Retrovir
Glibenclamide
HCT
Insaar
Lotyn
Metformin
Akilen
OMZ
Phenytoin
Sulfadoxin
Pyrimethamine
Radin
Neripros
Simvastatin
-
150 mg
3 mg
0.1 mg/dose
20 mg
40 mg
100 mg
Note: tab/cap = tablet or capsule
42
ANNEX 4 Data Collection Form

SURVEI HARGA OBAT NASIONAL BADAN LITBANG DEPKES RI
Formulir Pengumpulan Data Harga Obat F-1
Gunakan satu formulir untuk masing-masing fasilitas kesehatan

Tanggal:___/___/_____(tgl/bln/tahun
Nama Kota/: ______________________________________
Nama fasilitas kesehatan (pilihan) Name of health facility/pharmacy (optional
________________________________
Nomor identifikasi fasilitas kesehatan (wajib diisi):
_
Health facility/pharmacy ID (mandatory):
Jarak dari kecamatan terdekat yang berpenduduk > 50.000 :Distance in km from nearest town
(population >50 000):
,
km
Jenis fasilitas kesehatan berdasarkan kepemilikan: Type of health facility
Pemerintah Public
Apotik swasta Private retail
pharmacy
Lainnya (mohon dijelaskan) Other (please specify)

____________________________________________________
Jenis harga di fasilitas pemerintah dan sektor swasta nir laba: Type of price in public and private not-forprofit sector
Harga pembelian Procurement pric
Harga yang dibayarkan pasien Price the patient
pays
Nama apoteker pengelola apotek di fasilitas kesehatan: Name of manager of the facility
____________________
Nama responden yang memberikan informasi harga obat bila responden berbeda
dengan manajer: Name of person(s) who provided information on medicine prices (if not the manager)
____________________
Nama Enumerator: Data collectors ___________________________________
CONFIDENTIAL
43
VerifikasiVerification
Diselesaikan oleh kordinator lapangan setelah kunjungan selesai: To be completed
by the area supervisor at the end of the day
kode kordinator lapangan
Tanda tangan Signed: ____________________________
Tanggal Date: _________________________________
KODE Kordinator lapangan dan Enumerator

Drs Rachbudi Helmi APT
01
Dra. Selma Siahaan, MHA
02
Dr. Trijuni Angkasawati,

MSc
Dra Martuti Budiharto, MM
03
Siti Sundari, Ph.D
05
Dr. Luki Tjahjono, MKes
06
Nomor Lokasi:
Sumatera Selatan
DKI Jakarta
Jawa Timur
Kalimantan Selatan
Sulawesi Selatan
Papua
Nomor identifikasi fasilitas:
04
Drs. Adrimas, Apt

Elyta, SKM
Drg. Ratih Ariningrum, MKes
Drs. Moh. Annis, Apt
Fitira, Apt
Ikasetya Andri Vidianstiny, Apt
Hj. Noorhasanah
Noor Ipansyah, S.Si
Muh. Irwan A, S.Si, Apt
Hartadi, S.Si, Apt
Dra. Sariati Sirait, Apt
Dra. Diah Aryani, apt
01
02
03
04
05
06
07
08
09
10
11
12
Palembang
Lubuk Linggau
Jakarta Timur
Jakarta Pusat
Surabaya
Bondowoso
Banjarmasin
Martapura
Makasar
Gowa
Jayapura
Timika
01
02
03
04
05
06
07
08
09
10
11
12
Provinsi kab/kota - fasilitas
44
CONFIDENTIAL
FORMULIR PENGUMPULAN DATA HARGA OBAT F-1MEDICINE PRICE DATA COLLECTION FORM
Paling laku terjual: ditentukan dalam skala nasional Most sold: determined nationally
No
A
Nama generik, dosis, bentuk sediaan,
dan kekuatan Generic name, dosage form, strength
Harga terendah ditentukan di fasilitas Lowest price: determined at facility
B
C
Nama dagang Brand Pabrik Manufacturer
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
3S
5-S
Aciclovir tab 200 mg

Paling laku terjual untuk generik yang
sama Most sold generic equivalent
Harga terendah untuk generik yang
sama Lowest price generic equivalent
Amitriptyline tab 25 mg
Amlodipine tab/caps 5 mg
Amoxicillin caps/tab 250 mg
Amoxicillin caps/tab 500 mg
Zovirax
Acyclovir
GSK
Indofarma
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
direkomen ditemukanPa kemasan
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
25
25
/tab
25
Tryptizol
Amitriptilyn
MSD
Indofarma
100
100
/tab
100
Norvask
Tensivask
Pfizer
Dexa Medica
Amoxil
Amoxan
SKB (GSK)
Sanbe Farma
21
21
/tab
21
Amoxil
Amoxan
SKB (GSK)
Sanbe Farma
45
21
21
/tab
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
7-S
8-S

Atenolol tab 50 mg
Atorvastatin tab/caps 10 mg
Azithromycin tab/caps 500 mg
Beclometasone inhaler 50 mcg/ dose
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
21
Tenormin
Betablok
AstraZeneca
Kalbe Farma
60
60
/tab
60
Lipitor
Pfizer
Zithromax
Zistic
Pfizer
Benopharm
Becotide
GSK
Paling laku terjual untuk generik yang Cleril

Darya Varia
46
1 inhaler:
200 doses
1 inhaler:
200 doses
1 inhaler:
200 doses
/dose
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
10S Candesartan tab/caps 8 mg

11 Captopril tab 25 mg
12 Carbamazepine tab 200 mg
13 Ceftriaxone inj 1 g powder
14S Celecoxib tab/caps 200 mg
Blopress
Takeda
Capoten
Captopril
BMS
Indofarma
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
60
60
/tab
60
Tegretol
Carbamazepin
Novartis
Indofarma
100
100
/tab
100
Rocephin
Terfacef
Roche
Sanbe Farma
1 vial
1 vial
1 vial
Celebrex
Pfizer
47
/vial
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
15
Ciprofloxacin tab 500 mg

16 Co-trimoxazole paed suspension
(8+40) mg/mL
17 Diazepam tab 5 mg
18 Diclofenac tab 25 mg
19S Erythromycin tab/caps 250 mg
Ciproxin
Baquinor
Bayer
Sanbe Farma
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
1
1
/tab
1
Bactrim
Roche
100 mL
Cotrimoxazole
Pharos
100 mL
/mL
100 mL
Valium
Stesolid
Roche
Alpharma
100
100
/tab
100
Voltaren
Voltadex
Novartis
Dexa Medica
100
100
100
Erytrocyn
Erythromycin
Abbot
Indofarma
48
/tab
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
20S Esomeprazole tab/caps 20 mg

Nexium
21S Fluconazole caps/tab 150 mg
Diflucan
22
23

Fluoxetine caps/tab 20 mg
Fluphenazine decanoate inj 25 mg/mL
Zemyc
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
size recommended
Astra Zeneca
Pfizer
30
Pharos Indonesia
30
/tab Go to
supp list
Lilly
Kalbe Farma
30
30
/tab
30
Modecate

24S Ganciclovir inj 500 mg
Cymevene
Comments
price (4 digits)
30
Prozac
Kalxetin
I
Catatan
Sanofi-Winthrop/
BMS
1 ampoule
1 ampoule
1 ampoule
Roche
49
/mL
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
25
Glibenclamide tab 5 mg
26 Hydrochlorothiazide tab 25 mg
27S Lisinopril tab/caps 20 mg
28 Losartan tab 50 mg
29 Lovastatin tab 20 mg
Daonil
Glibenclamide
HMR
Indofarma
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
60
60
/tab
60
Dichlotride
HCT
MSD
Kimia Farma
30
30
/tab
30
Zestril
Astra Zeneca
Cozaar
Insaar
MSD
Interbat
30
30
/tab
30
Mevacor
Lotyn
MSD
Interbat
60
60
60
50
/tab
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
30
Metformin tab 500 mg

31 Nifedipine Retard tab 20 mg
32S Ofloxacin tab/caps 200 mg
33S Olanzapine tab/caps 5 mg
34 Omeprazole caps 20 mg
Glucophage
Metformin
Merck
Dexa Medica
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
100
100
/tab
100
Adalat Retard
Bayer
100
100
/tab
100
Tarivid
Akilen
Kalbe Farma
Sanbe
Zyprexa
Lilly
Losec
OMZ
AstraZeneca
Ferron Par Pharm
30
30
30
51
/caps
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
35
Phenytoin caps/tab 100 mg

36 Pyrimethamine with sulfadoxine tab
(25+500) mg
37 Ranitidine tab 150 mg
38S Risperidone tab/caps 3 mg
39 Salbutamol inhaler 0.1 mg per dose
Epanutin
Phenytoin
Pfizer
Ikapharmindo
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
100
100
/tab
100
Fansidar
Roche
Sulfadoxin
Pyrimethamine
Indofarma
/tab
3
Zantac
Radin
GSK
Dexa Medica
60
60
/tab
60
Risperdal
Neripros
Jansen
Pharos Indonesia
Ventoline
GSK
1 inhaler:
200 doses
1 inhaler:
200 doses
1 inhaler:
200 doses

52
/dose
I
Catatan
Comments
No
A
B
C
name(s)
D
Cek
Jika
tersedia
Available tick
for yes
40S Simvastatin tab/caps 20 mg

Zokor
Paling laku terjual untuk generik yang Simvastatin
41S Stavudine tab/caps 40 mg
Zerit
42

Zidovudine caps 100 mg
Retrovir
E
F
G
Kemasan Kemasan
Harga
yang
yang
per
ck size found
Price of pack
dasi Pack
found
H
Harga
satuan Unit
price (4 digits)
size recommended
MSD
Dexa Medica
Bristol Myers
Squibb
GSK
100
100
100
53
/caps
I
Catatan
Comments
ANNEX 5
Medicine availability (%) in public and private sector
Generic name
Aciclovir
Amitriptyline
Amlodipine
Amoxicillin
Amoxicillin
Atenolol
Beclometasone
Captopril
Carbamazepine
Ceftriaxone
Ciprofloxacin
Co-trimoxazole
Diazepam
Diclofenac
Erythromycin
Fluconazole
Fluoxetine
Fluphenazine decanoate
Glibenclamide
Hydrochlorothiazide
Lisinopril
Losartan
Lovastatin
Metformin
Nifedipine Retard
Omeprazole
Phenytoin
Pyrimethamine with
sulfadoxine
Ranitidine
Salbutamol
Simvastatin
Stavudine
Zidovudine
Strength
Form
200 mg
25 mg
5 mg
250 mg
500 mg
50 mg
0.05
mg/dose
25 mg
200 mg
1 g/vial
500 mg
(8+40)
mg/ml
5 mg
25 mg
250 mg
150 mg
20 mg
25 mg/ml
5 mg
25 mg
20 mg
50 mg
20 mg
500 mg
20 mg
20 mg
100 mg
(25+500)
mg
150 mg
0.1
mg/dose
20 mg
40 mg
100 mg
tablet
tablet
tab/cap
tab/cap
tab/cap
tablet
inhaler
% availability
Innovator Brand
MSG
Public
Private
Public
Private
6.7
31.0
26.7
56.9
0
0
53.3
70.7
53.3
82.8
0
0
6.7
15.5
33.3
72.4
13.3
32.8
66.7
96.6
13.3
25.9
20.0
53.4
0
1.7
0
0
LPG
Public
Private
73.3
91.4
60.0
74.1
53.3
62.1
60.0
82.8
93.3
100.0
33.3
62.1
0
0
tablet
tablet
injection
tablet
suspensi
on
tablet
tablet
tab/cap
tab/cap
tab/cap
injection
tablet
tablet
tab/cap
tablet
tablet
tablet
tablet
capsule
tab/cap
tablet
33.3
6.7
6.7
6.7
6.7
51.7
65.5
15.5
27.6
31.0
53.3
60.0
20.0
40.0
13.3
58.6
69.0
31.0
81.0
25.9
93.3
60.0
60.0
80.0
53.3
98.3
70.7
51.7
93.1
77.6
6.7
20.0
0
13.3
0
0
20.0
0
0
0
0
33.3
6.7
6.7
0
13.3
48.3
65.5
17.2
43.1
17.2
12.1
75.9
0
8.6
10.3
0
70.7
15.5
27.6
0
70.7
13.3
20.0
20.0
0
0
0
53.3
73.3
0
26.7
6.7
0
0
26.7
20.0
20.0
50.0
39.7
36.2
0
0
0
70.7
79.3
0
51.7
20.7
0
0
51.7
41.4
19.0
80.0
60.0
40.0
6.7
13.3
0
73.3
86.7
0
40.0
6.7
46.7
0
73.3
33.3
33.3
81.0
74.1
65.5
10.3
29.3
0
96.6
89.7
0
62.1
25.9
50.0
0
87.9
60.3
43.1
tablet
inhaler
20
13.3
46.6
56.9
33.3
0
48.3
0
80.0
0
84.5
0
tab/cap
tab/cap
tab/cap
0
0
6.7
1.7
1.7
5.2
46.7
0
0
29.3
0
0
46.7
0
0
31.0
0
0
54
ANNEX 6
List of Median Medicine Price Ratios from Public and Private Sectors
55
Generic name
Strength
Aciclovir
Amitriptyline
Amlodipine
Generic name
Amoxicillin
Amoxicillin
Atenolol
Aciclovir
Beclometasone
200 mg tablet
Amitriptyline
Captopril
25 mg tab
Carbamazepine
Amlodipine
Ceftriaxone
5mg tab
Ciprofloxacin
Amoxicillin
Co-trimoxazole
250 mg tab
Amoxicillin
Diazepam
500 mg tab
Diclofenac
Atenolol
Erythromycin
50 mg tab
Fluconazole
Captopril
Fluoxetine
25 mg tab
Fluphenazine
decanoate
Carbamazepine
Glibenclamide
200 mg tab
Hydrochlorothiazide
Ceftriaxone
Lisinopril
1g/vial inj
Losartan
Ciprofloxacin
Lovastatin
500 mg tab
Metformin
Co-trimoxazole
Nifedipine
Retard
(8+40)ml
susp
Omeprazole
Diazepam
Phenytoin
5 mg tab
Pyrimethamine
Diclofenac with
sulfadoxine
25 mg tab
Ranitidine
Salbutamol
Simvastatin
Stavudine
Zidovudine
200 mg
25 mg
5 mg
250 mg
500 mg
I
50 mg
0.05
mg/dose
25 mg
200
mg
50.95
1 g/vial
500 mg
(8+40)
mg/ml
5 mg
25 mg
250 mg
150
mg
20.88
20 mg
25 mg/ml
18.15
5 mg
25 mg
20 mg
50 mg
20 mg
500 mg
20 mg
20
mg
92.29
100 mg
(25+500)
56.28
mg
150 mg
0.1
mg/dose
20 mg
40 mg
100 mg
ANNEX 7 Median Medicines

MPR
Price Ratios in Private Sector
Form
Innovator Brand
MSG
LPG
by regions
Public
Private
Public
Private
Public
Private
tablet
10.18
1.40
1.36
1.38
1.37
tablet
2.14
2.23
2.15
2.23
tab/cap
51.13
53.26
45.85
49.43
MPR
tab/cap Brand
15.22
9.96
10.83
2.31
Innovator
Most Sold
Generic2.33
tab/cap
11.85
9.59
9.99
1.77
II
III
IV
I
II
III
IV 1.82 I
II
III
IV
tablet
75.07
21.32
18.58
20.44
10.32
1.28
1.31
1.37
1.46
1.28
1.31
1.39
1.48
inhaler
tablet
tablet
53.39
injection
tablet
15.29
suspensi
11.86on
tablet
tablet
75.86
tab/cap
tab/cap
23.06
tab/cap
injection
18.57
tablet
tablet
13.70
tab/cap
tablet
90.56
tablet
tablet
46.09
tablet
capsule
109.23
tab/cap
tablet
59.34
tablet
inhaler
tab/cap
tab/cap
tab/cap
21.80
53.13
22.91
18.92
2.00
2.23
2.25
1.96
22.78
1.69
1.70
1.69
1.71
18.92
2.84
2.81
2.84
2.81 47.59
55.56
13.02
7.12
1.41
1.49
90.08 10.4540.49 10.6842.22 10.82 6.03 11.57 7.78 2.06
43.81
2.19
2.12
2.27
101.96
59.09
10.75
92.44
22.02
54.10
19.79
20.28
79.45
2.23
2.25
49.68
47.70
51.71
2.24
10.17
2.71
1.54
1.91
2.01
17.23
20.63
23.41
1.50
1.71
1.97
2.84
2.81
3.07
2.79
5.51
5.59
5.51
5.74
0.70 7.00 0.81
0.70
0.81 2.84
2.84
2.81
3.02
1.41
5.37
1.49
1.00 7.36
8.16
2.62 2.21
7.30
8.44
7.84
2.42
2.22
2.56
1.73 6.26
7.00
6.84
27.67
2.75 6.88
5.53
10.25
7.71
9.56
9.99
9.99
10.71
1.51
53.66
5.32
6.77
21.32 6.64 20.63 9.41 23.23 6.69 16.25
2.25
2.17
2.42
47.33
1.53
1.71
2.08
1.62
18.98
1.62
2.79
6.18
1.40 40.490.96 42.24 1.03 42.22 0.95 43.94
8.81
6.15
6.97
2.65
2.19 2.54
23.34
6.56
9.48 48.97
95.45
52.64 6.84 53.66 1.66 56.43
21.46
59.09
62.7430.1 7.51
5.07 2.31 5.13 2.70 7.71
25.89
4.49
6.88
7.51
3.40
3.43
7.27
8.32
7.27
8.32
56
Generic name
I
Erythromycin
250 mg tab
Fluconazol
150 mg tab
Fluoxetine
20 mg tab
Fluphenazine decanoate
25 mg/ml inj
Glibenclamide
5 mg tab
Hydrochlorothiazide
25 mg tab
Losartan
50 mg tab
Lovastatin
20 mg tab
Metformin
500 mg tab
Nifedipine Retard
20 mg tab
Omeprazole
20 mg caps
Phenytoin
100 mg tab
Pyrimethamine +
sulfadoxine (25+500)mg
Ranitidine
150 mg tab
Salbutamol
0.1 mg/dose inh
Simvastatin 20 mg tab
Innovator Brand
II
III
IV
10.75
92.74
MPR
Most Sold Generic
II
III
2.40
2.22
IV
2.27
I
2.22

II
III
IV
2.25
2.42
3.95
17.53
21.04
5.51
5.51
5.64
6.88
1.93
0.71
0.77
0.81
1.93
1.06
1.02
0.98
0.99
1.06
8.30
7.62
3.23
2.53
2.85
1.66
1.58
1.76
1.80
23.08
23.41
48.34
41.73
10.10
2.44
3.38
3.43
3.76
8.45
8.32
92.35
54.95
19.79
75.70
79.58
79.45
1.48
95.44
1.06
5.60
5.51
5.59
0.71
0.79
0.81
1.02
0.97
8.64
6.54
7.01
6.97
7.93
24.71
9.69
9.46
26.35
30.49
28.90
24.81
27.05
25.89
4.71
4.49
4.96
31.23
6.57
6.77
23.08
24.12
6.84
2.46
7.18
7.60
7.48
8.45
8.32
7.16
2.44
2.42
8.30
3.22
5.28
57
ANNEX 8 A list of Standard Treatment Affordability

Standard Treatment
Affordability
Daily wage of lowest paid government worker (in local currency):
Diabetes
20700
Public Procurement
Select Medicine Name
Medicine
Strength
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Glibenclamide
5 mg
cap/tab
30
60
Days'
Wages
Median
Treatment
Price
Days'
Wages
Most Sold
9508.50
0.5
12000.00
0.6
Lowest Price
9945.90
0.5
12000.00
0.6
Product Type
Brand
Public Procurement
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Hydrochlorothiazide
25 mg
cap/tab
30
30
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Atenolol
50 mg
cap/tab
30
30
Median
Treatment
Price
Days'
Wages
173160.00
8.4
12180.00
0.6
12510.00
0.6
Private Retail
Median
Treatment
Price
Days'
Wages
Other Patient
Days'
Wages
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
Most Sold
540.90
0.0
649.20
0.0
750.00
0.0
712.50
0.0
Lowest Price
532.95
0.0
649.20
0.0
750.00
0.0
750.00
0.0
Product Type
Brand
Public Procurement
Dosage
Form
Public Patient
Other Patient
Median
Treatment
Price
Hypertension
Medicine
Strength
Private Retail
Median
Treatment
Price
Hypertension
Medicine
Strength
Public Patient
Product Type
Median
Treatment
Price
Days'
Wages
Public Patient
Median
Treatment
Price
Private Retail
Days'
Wages
Brand
Most Sold
Lowest Price
Adult resp. infects.
45919.50
Public Procurement
58
Public Patient
2.2
Other Patient
Median
Treatment
Price
Days'
Wages
185580.00
9.0
52700.00
2.5
50535.00
2.4
Private Retail
Median
Treatment
Price
Days'
Wages
Other Patient
Medicine
Strength
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Amoxicillin
250 mg
cap/tab
21
Product Type
Median
Treatment
Price
Days'
Wages
Lowest Price
Pediatric resp. infecs.

Co-trimoxazole
suspension
5573.57
0.3
Public Procurement
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
millilitre
70
Days'
Wages
31878.00
1.5
7455.00
0.4
Brand
Most Sold
Medicine
Strength
8+40
mg/ml
Median
Treatment
Price
Product Type
Median
Treatment
Price
Days'
Wages
Public Patient
Median
Treatment
Price
Days'
Wages
Most Sold
Lowest Price
4036.67
0.2
Public Procurement
Medicine
Strength
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Ciprofloxacin
500 mg
cap/tab
Product Type
Median
Treatment
Price
Days'
Wages
Lowest Price
Arthritis
1786.48
0.1
Public Procurement
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Diclofenac
25 mg
cap/tab
30
60
0.2
Public Patient
Median
Treatment
Price
Product Type
Median
Treatment
Price
Days'
Wages
Days'
Wages
Depression
0.7
Public Procurement
59
1.7
7406.70
0.4
Median
Treatment
Price
Days'
Wages
97825.00
4.7
4900.00
0.2
5075.00
0.2
Median
Treatment
Price
Days'
Wages
25378.75
1.2
11894.00
0.6
0.1
2192.00
0.1
Median
Treatment
Price
Private Retail
Days'
Wages
25500.00
Public Patient
1.2
8484.00
0.4
Median
Treatment
Price
Days'
Wages
5140.10
0.2
Median
Treatment
Price
Days'
Wages
1050.00
0.1
Other Patient
Median
Treatment
Price
Days'
Wages
160200.00
7.7
18000.00
0.9
18960.00
0.9
Private Retail
Days'
Wages
Other Patient
0.6
Public Patient
Median
Treatment
Price
Other Patient
1700.00
Most Sold
14398.80
2.4
34650.00
11409.00
Brand
Lowest Price
48720.00
Private Retail
Brand
Most Sold
Medicine
Strength
4741.63
Days'
Wages
Private Retail
Brand
Gonorrhoea
Median
Treatment
Price
Median
Treatment
Price
Days'
Wages
Other Patient
Medicine
Strength
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Amitriptyline
25 mg
cap/tab
30
90
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
Most Sold
9271.80
0.4
12987.00
0.6
13500.00
0.7
Lowest Price
9405.00
0.5
13050.00
0.6
13500.00
0.7
Product Type

Salbutamol inhaler
Public Procurement
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
dose
as needed
200
Days'
Wages
Brand
Asthma
Medicine
Strength
0.1
mg/dose
Median
Treatment
Price
Product Type
Median
Treatment
Price
Days'
Wages
Public Patient
Median
Treatment
Price
Private Retail
Days'
Wages
Brand
Other Patient
Median
Treatment
Price
Days'
Wages
85750.00
4.1
Median
Treatment
Price
Days'
Wages
Most Sold
Lowest Price
Peptic ulcer
Public Procurement
Medicine
Strength
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Ranitidine
150 mg
cap/tab
30
60
Product Type
Median
Treatment
Price
Days'
Wages
Lowest Price
Diabetes
111600.00
5.4
Public Procurement
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Metformin
500 mg
cap/tab
30
90
Median
Treatment
Price
Private Retail
Days'
Wages
Brand
Most Sold
Medicine
Strength
Public Patient
Product Type
Median
Treatment
Price
Days'
Wages
Brand
Other Patient
Median
Treatment
Price
Days'
Wages
342660.00
16.6
91080.00
4.4
99345.00
4.8
45000.00
2.2
45390.00
2.2
Public Patient
Private Retail
Median
Treatment
Price
Days'
Wages
Other Patient
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
87337.80
4.2
99000.00
4.8
36000.00
1.7
37170.00
1.8
Median
Treatment
Price
Days'
Wages
Most Sold
Lowest Price
Depression
Public Procurement
60
Public Patient
Private Retail
Other Patient
Medicine
Strength
Dosage
Form
Treatment
Duration
(in Days)
Total # of
Units per
Treatment
Fluoxetine
20 mg
cap/tab
30
60
Product Type
Brand
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
Median
Treatment
Price
Days'
Wages
848334.43
41.0
297660.00
14.4
Most Sold
Lowest Price
61
Median
Treatment
Price
Days'
Wages
62

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THE PRICES PEOPLE HAVE TO PAY FOR MEDICINES

Center for Health Services and Technology Research

ASIH EKA PUTRI

Data Analysts from National Institute of

Conclusions and recommendations

The availability of medicines in public sector, especially in public procurement, is far

Indonesian public health sector is inefficient in procurement as prices obtained are on

5. Inefficient public procurement should be elaborated and solved by following possible

Competitive tender with price transparency

Use international reference prices as guidelines

Introduce tender procurement for hospitals

6. In-depth analysis on generic medicines pricing should be undertaken in order to avoid

1. Introduction and Background

Geography, population, administrative structure and macro economy

Health system and pharmaceutical regulation

Figure 1: Study Sites

hydrochlorothiazide, metformin, pyrimethamine+sulfadoxine, ranitidine. Eight of these are

National Institute of Health Research and Development (Host Institute)

Directorate of Pharmacy and Medical Devices, Ministry of Health (Collaborator and

National Agency of Food and Drug Control (Collaborator)

Management Science for Health Indonesia (Collaborator)

Indonesian Pharmaceutical Association (Collaborator)

WHO Indonesia Office (Collaborator)

Provincial Health Offices 6 provinces (Collaborator)

District Health Offices 12 districts (Collaborator and local investigator)

3. Data Collection and Analysis

Innovator Brand (IB)

Procurement prices were collected from 16 primary healthcare centers. 15 of the 33

4.3 Public sector patient prices and availability

Median of the lowest

Most Sold Generic

Lowest Price Generic

Comparing matched pairs of medicines

Aciclovir, amoxicillin 250mg, amoxicillin 500mg, captopril, ciprofloxacin,

Figure 2. Summary of median MPRs for medicines found in private sector, by

4.8 Treatment affordability

6. Conclusions and recommendations

The availability of medicines in public sector, especially in public procurement, is far

Indonesian public health sector is inefficient in procurement as prices obtained are on

Competitive tender with price transparency

Use international reference prices as guidelines

Introduce tender procurement for hospitals

6. In-depth analysis on generic medicines pricing should be undertaken in order to avoid

National Pharmaceutical Sector form

General information on the pharmaceutical sector

If yes, state total number of medicines on national EML: 369

Is there a policy for generic prescribing or substitution?

Type of public sector procurement (tick all that apply):

Are the products purchased all registered? Yes>

If yes, specify levels: district level

Are there private not-for-profit distribution centres:

Number of licensed wholesalers: 2,478

Number of inhabitants per qualified pharmacist

Number of medicine outlets with pharmacy

Number of other licensed medicine outlets

If yes, approximate coverage or % of doctors who dispense: NA

Are there pharmacies or medicine outlets in health facilities?

Cyanocobalamin (vitamin B12) inj. 500 mcg

Lidocaine inj.2% (HCl) + Epinephrine 1 : 80.000 2ml

Quinine tablet 22 mg (H2SO4.7H2O)

Ranitidine tablet 150 mg

Note: tab/cap = tablet or capsule

ANNEX 4 Data Collection Form